With all the media coverage of supposed cost overruns and genuine IT troubles for North Carolina’s Medicaid program (the public health insurance system for low income people), many often forget how limited Medicaid coverage actually is. For instance, while Medicaid covers many adults with disabilities, many others are left out completely. Consider the following rather remarkable facts about health insurance for people with disabilities in North Carolina:
The biggest myth is that all people with disabilities are automatically eligible for Medicaid or some other public insurance program. This is a vast oversimplification. A significant percentage of people with disabilities have no insurance – privately or publicly funded. That will improve on January 1, 2014 when pre-existing conditions can no longer be used to deny or increase premiums for individual health insurance. But some people with disabilities have gone years without insurance and may not realize their preexisting condition is no longer a barrier to coverage. People with disabilities need accurate information about their eligibility for coverage and potential subsidies under the Affordable Care Act.
But let’s get back to Medicaid. Until recently, people with disabilities in North Carolina were only eligible for Medicaid if they had income below 100 percent of the federal poverty level. For a single adult that is $11,490 per year. Many North Carolinians who are eligible for Social Security Disability Insurance are ineligible for Medicaid because at an income of, for example, $1,200 per month, their incomes are too high!
Fortunately the state has begun long overdue full implementation of a program called Health Coverage for Workers with Disabilities. This program, authorized by the General Assembly, makes it possible for people with disabilities to return to work and seek more hours or higher wages without fear of losing access to health care. For those who are eligible, this program means they don’t have to lose health insurance just because they pick up a few extra hours at work.
Still those who have a disability and do not work remain ineligible for Medicaid if their non-wage income, including Social Security retirement or Social Security Disability Insurance payments, is more than about $960 per month. Just imagine the rollercoaster of emotions of a woman we met recently whom I’ll call “Sandra.” Her annual cost of living adjustment to her Social Security payment brought her an extra few dollars each month, money she felt would just give her enough breathing room to meet all her copayment and utility payments.
She was relieved until she learned that the small increase in Social Security each month would make her ineligible for Medicaid. She relied on Medicaid for her prescriptions and doctors’ visits as well as the personal care service that helped her remain independent in her home. Without Medicaid those health care costs would add up to $1,200 each month. That was more than her entire monthly Social Security check. A social worker at her local senior center suggested that if Sandra moved to an adult care home she could keep Medicaid. But Sandra was doing fine in her own home and couldn’t imagine living in a place where her daughter and grandson would not even have a couch to come stay the night after they drove the six hours to visit. Ironic that someone must become more dependent on public dollars solely because of the lack of affordable health insurance.
Of course, Sandra and over 500,000 other low-income North Carolinians would have remained eligible for Medicaid under the expanded eligibility definitions set out in the Affordable Care Act if North Carolina had, like so many other states, elected to expand Medicaid eligibility. Unfortunately, this has not been the case.
People with disabilities do not live in a vacuum. They have families and friends. They are part of the fabric of our communities. And, like all other North Carolinians, when uninsured, people with disabilities and their families and their communities are vulnerable to inaccessible health care and the financial devastation of a health crisis.
There are solutions to these problems. We must provide accurate information about eligibility for health care options. We must make sure that IT systems are accessible to people with disabilities. We must fully implement Health Coverage for Workers with Disabilities program so people are not afraid to work to their potential. And we must expand Medicaid eligibility to people slightly above the poverty level as is provided for in the Affordable Care Act.
The bottom line: If North Carolina wants to help people with disabilities, we must remove unnecessary barriers to healthcare as soon as possible.
Vicki Smith is the Executive Director of Disability Rights North Carolina.